Résumé
RESUMO Ao longo da vida, o cristalino produz novas fibras dispostas de forma concêntrica, que aumentam seu diâmetro anteroposterior e peso, tornando seu núcleo mais compacto e endurecido. A catarata hipermadura é uma forma de progressão avançada dessa proliferação de fibras, que pode desencadear uma variedade de complicações. A ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo, é uma complicação rara e com poucos casos publicados na literatura. Descrevemos o caso de uma paciente do sexo feminino, 68 anos, que apresentou ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho esquerdo sem histórico de trauma ocular. A paciente foi submetida à facoemulsificação do cristalino e ao controle da pressão intraocular, evoluindo com melhora do quadro clínico.
ABSTRACT Throughout life, the lens produces new fibers arranged concentrically, which increase its anteroposterior diameter and weight, making its nucleus more compact and hardened. Hypermature cataract is an advanced stage of this fiber proliferation, which can trigger a variety of complications. Spontaneous rupture of the anterior lens capsule evolving with anterior displacement of the nucleus is a rare complication, with few cases published in the literature. We describe the case of a 68-year-old female patient, who presented spontaneous rupture of the anterior lens capsule with anterior displacement of the nucleus in the left eye, without a history of ocular trauma. The patient underwent phacoemulsification and clinical control of intraocular pressure, improving her condition.
Sujets)
Humains , Femelle , Sujet âgé , Cataracte/complications , Subluxation du cristallin/diagnostic , Subluxation du cristallin/étiologie , Capsule antérieure du cristallin/anatomopathologie , Rupture spontanée/chirurgie , Cataracte/thérapie , Glaucome néovasculaire , Subluxation du cristallin/chirurgie , Échographie , Phacoémulsification/méthodes , Biomicroscopie , Pression intraoculaire , Noyau du cristallin/anatomopathologie , Chambre antérieure du bulbe oculaire/anatomopathologieRésumé
Objetivo: Determinar la relación de los planos anatómicos del cristalino con la posición real de la lente intraocular en pacientes con diagnóstico de catarata atendidos en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología durante el período de enero del 2018 a enero 2021. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo longitudinal en 89 ojos de 67 pacientes operados de catarata con implante de lente intraocular (LIO) por técnica de facoemulsificación. Se empleó para el cálculo del poder de la lente el IOL Master 700 y la fórmula de SRK/T. Se utilizó la imagen de OCT ofrecida por el IOL Máster 700 para determinar el plano ecuatorial y plano central del cristalino, así como la posición real de la lente intraocular. Resultados: Predominó el grupo de edad entre 60 - 79 años, el sexo femenino representó el 53 por ciento. Los ojos tamaño promedio y las medidas biométricas oculares en valores promedios estándar fueron los más representativos. El plano ecuatorial mostró menos diferencia con la posición real de la lente intraocular en comparación con la diferencia evidenciada entre el plano central y la posición real de la lente. La adecuada posición del lente intraocular calculado en la bolsa capsular independiente a la longitud axial, permitió obtener un resultado refractivo en correspondencia al esperado previo a la cirugía. Conclusión: Los parámetros anatómicos del cristalino (plano ecuatorial, plano central) constituyen variables importantes a tener en cuenta para el desarrollo y perfeccionamiento de las fórmulas para el cálculo del lente intraocular(AU)
Purpose: To determine the relationship of the anatomical planes of the crystalline lens with the actual position of the intraocular lens in patients with a diagnosis of cataract seen at the Ocular Microsurgery Center of the Cuban Institute of Ophthalmology during the period January 2018 and January 2021. Methods: An observational, descriptive, prospective longitudinal study was performed in 89 eyes of 67 patients operated on for cataract with intraocular lens implantation (IOL) by phacoemulsification technique. The IOL Master 700 and the SRK/T formula were used to calculate lens power. The OCT image provided by the IOL Master 700 was used to determine the equatorial plane and central plane of the crystalline lens, as well as the actual position of the intraocular lens. Results: The age group 60-79 years was predominant, female gender represented 53 percent. Average eye size and ocular biometric measurements in standard average values were the most representative. The equatorial plane showed less difference with the actual intraocular lens position compared to the difference evidenced between the central plane and the actual lens position. The adequate position of the intraocular lens calculated in the capsular bag independent to the axial length, allowed to obtain a refractive result in correspondence to the one expected before surgery. Conclusion: The anatomical parameters of the crystalline lens (equatorial plane, central plane) are important variables to be taken into account for the development and improvement of the formulas for the calculation of the intraocular lens(AU)
Sujets)
Femelle , Sujet âgé , Cataracte/diagnostic , Épidémiologie Descriptive , Études prospectives , Études observationnelles comme sujetRésumé
La capacidad de ver bien es una preocupación para todos, especialmente a medida que se envejece. Los cambios en los ojos con el tiempo son inevitables, pero existen opciones de tratamiento para ayudar a tratar los problemas que pueden aparecer en la visión. El síndrome de disfunción del cristalino se caracteriza por englobar algunas de las alteraciones visuales más comunes relacionadas con la edad y que suelen aparecer a partir de los 40 años. La principal causa del síndrome de disfunción del cristalino es el envejecimiento natural de esta estructura ocular. Los síntomas más comunes son visión borrosa, disminución de la sensibilidad a los colores o dificultad y cambios en la visión cercana. El término es poco usado en Cuba por lo que el objetivo fue realizar una revisión sobre el síndrome de disfunción del cristalino y su intercambio refractivo. Existen diferentes opciones de tratamiento, desde gafas hasta el recambio refractivo del cristalino por una lente intraocular, que se usa cada vez a más temprana edad y que gracias al adelanto tecnológico y aumento de la pericia del médico, constituye un tratamiento eficaz en pacientes pregeriátricos(AU)
The ability to see well is a concern for everyone, especially as one ages. Changes in the eyes over time are inevitable, but there are treatment options to help address the problems that can occur in vision. The lens dysfunction syndrome is characterized as encompassing some of the most common age-related visual disorders that usually appear after the age of 40. The main cause of lens dysfunction syndrome is the natural aging of this ocular structure. The most common symptoms are blurred vision, decreased sensitivity to colors or difficulty and changes in near vision. The term is hardly ever used in Cuba, so the objective was to review the crystalline lens dysfunction syndrome and its refractive exchange. There are different treatment options, from glasses to the refractive exchange of the crystalline lens for an intraocular lens, which is used at an increasingly younger age and which, thanks to technological advances and increased medical expertise, is an effective treatment in pregeriatric patients(AU)
Sujets)
Humains , Maladies du cristallin/étiologieRésumé
ABSTRACT Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.
RESUMO A clorpromazina é uma medicação muito empregada na psiquiatria para tratamento de psicoses, especialmente em casos de esquizofrenia. Desde 1964 existem artigos publicados que correlacionam o uso dessa medicação com o aparecimento de alterações oculares. Neste trabalho, relatamos o caso de um paciente de 65 anos com efeitos oculares devido à terapia de longo prazo com clorpromazina. A biomicroscopia de ambos os olhos apresentou depósitos granulares difusos e de cor marrom, mais proeminente ao nível do estroma profundo e do endotélio da córnea, além de depósitos castanhos subcapsulares anteriores centrais em um padrão estrelado no cristalino. Considerando a dose diária de clorpromazina de 300mg por 10 anos usada pelo paciente, a quantidade total ultrapassa 2.000g (dose considerada significativa para as alterações oculares descritas). Após avaliação oftalmológica completa e descartado outras causas desses depósitos oculares, foram diagnosticados depósito corneano e catarata secundários ao uso de clorpromazina. O caso apresentado reforça a importância do acompanhamento oftalmolÓgico periÓdico de usuários de clorpromazina para o rastreio de alteraçÕes oculares, atentando-se ao tempo de exposição à droga e à posologia da mesma.
Sujets)
Humains , Mâle , Sujet âgé , Cataracte/induit chimiquement , Chlorpromazine/effets indésirables , Chlorpromazine/toxicité , Cornée/effets des médicaments et des substances chimiques , Maladies de la cornée/induit chimiquement , Opacité cornéenne/induit chimiquement , Troubles de la pigmentation/induit chimiquement , Neuroleptiques/effets indésirables , Neuroleptiques/toxicité , Neuroleptiques/usage thérapeutique , Trouble bipolaire/traitement médicamenteux , Acuité visuelle , Chlorpromazine/administration et posologie , Chlorpromazine/usage thérapeutique , Maladies de la cornée/diagnostic , Opacité cornéenne/diagnostic , Lampe à fente , BiomicroscopieRésumé
Abstract The contribution of the herbaceous stratum to tropical plant diversity is considerable, however this component remains undersampled. We investigated floristic, structural, ecological and conservation issues concerning the herbaceous component of a seasonal deciduous forest associated with granitic rock outcrops in the Cristalino Region, a key area for biodiversity conservation in the Brazilian Amazon. We installed a permanent plot of 1 ha, allocating 10 transect-lines of 20 m each. We identified the sampled individuals, measured height and projection, and verified cover and frequency per species, genera and family. We recorded 86 species, 62 genera and 25 families, with Orchidaceae being the family with the highest species richness. Among the 26 new species added to Cristalino Flora, we included Philodendron deflexum Poepp. ex Schott and Griffinia nocturna Ravenna, the latter 'Critically Endangered'. Furthermore, the occurrence of G. nocturna in an Amazonian forest matrix is a novelty in this study. The estimate of species diversity according to Shannon-Wiener (H') was 2.43 nats.ind.-1 (equivalent to 11.37 ± 0.90 IC95% equally common species), and according to Simpson (1/D), 6.82 (± 0.648 IC95%). The rarefaction and extrapolation curves for the diversity estimates tended to stabilize. Although the vegetation on rock outcrops usually presents a high number of endemic species, this pattern was not found in our study area, which can be explained by its continuous occurrence in the forest matrix. The understory of our study area consists in a mixture of floras, being composed mainly of species from the Amazon and/or Cerrado biomes. In view of the current anthropic pressure faced by the southern Amazon, we reinforce the importance of carrying out inventories of its herbaceous communities, since the risk of species loss is even more alarming when considering present undersampling of this component.
Resumo A contribuição do estrato herbáceo para a diversidade de plantas tropicais é considerável, mas esse componente permanece subamostrado. Investigamos questões florísticas, estruturais, ecológicas e de conservação relacionadas ao componente herbáceo de uma floresta estacional decidual associada a afloramentos rochosos graníticos na região do Cristalino, que é uma área chave para a conservação da biodiversidade na Amazônia brasileira. Instalamos um plot permanente de 1 ha, alocando 10 linhas de 20 m cada. Identificamos os indivíduos amostrados, medimos altura e projeção e verificamos cobertura e frequência por espécie, gênero e família. Registramos 86 espécies, 62 gêneros e 25 famílias, sendo Orchidaceae a família com maior riqueza de espécies. Entre as 26 novas espécies adicionadas à Flora do Cristalino, incluímos Philodendron deflexum Poepp ex Schott e Griffinia nocturna Ravenna, esta última 'Criticamente Ameaçada'. Além disso, a ocorrência de G. nocturna em uma matriz florestal amazônica é uma novidade neste estudo. A estimativa da diversidade de espécies de acordo com Shannon-Wiener (H ') foi 2,43 nats / ind.-1 (equivalente a 11,37 ± 0,90 IC95% espécies igualmente comuns), e de acordo com Simpson (1/D), 6,82 (± 0,648 IC95%). As curvas de rarefação e extrapolação para as estimativas de diversidade tenderam à estabilização. Embora a vegetação associada a afloramentos rochosos em geral apresente um elevado número de espécies endêmicas, esse padrão não foi encontrado para a nossa área de estudo, o que pode ser explicado pela sua ocorrência contínua à matriz florestal. O sub-bosque da nossa área de estudo apresenta mistura de floras, sendo composto principalmente por espécies dos biomas Amazônia e/ou Cerrado. Diante das pressões antrópicas existentes no sul da Amazônia, reforçamos a importância da realização de inventários das comunidades herbáceas desse bioma, já que o risco de perda de espécies é ainda mais alarmante quando consideramos a subamostragem desse componente.
Résumé
Resumen La estructura cristalina del compuesto ácido 2-E-((4-hidroxifenil) diazenil) benzoico se resolvió por medio del método de fase intrínseca usando datos de difracción de rayos X de monocristal, encontrando que la molécula cristaliza en el sistema cristalino ortorrómbico con grupo espacial Pbca. Dentro de su celda unidad hay cuatro moléculas por unidad asimétrica que son confórmeros moleculares. Estos confórmeros forman hélices beta a lo largo de la dirección [010]. A partir de los datos estructurales se realizó el cálculo de superficies de Hirshfeld determinando, a partir de ellas, sus correspondientes diagramas de huellas dactilares bidimensionales, lo que permitió estudiar las interacciones intermoleculares que más contribuyen al empaquetamiento cristalino. Así, se pudo determinar que la principal contribución a la superficie general está dada por los contactos H•••H (34,8%), seguida de interacciones O•••H/ H•••O (27%) y C•••H/H•••C (18,6%). También fueron calculadas las redes energéticas de interacción con un nivel de teoría DFT/B3LYP/6-31G(d,p), permitiendo cuantificar los valores de cada componente que aportan a la energía total, siendo las interacciones de dispersión (-57,5 kJ/mol) las que más contribuyen en la formación del empaquetamiento cristalino para este compuesto.
Abstract The crystalline structure of 2-E-((4-hydroxyphenyl) diazenil) benzoic acid compound was solved by intrinsic phase method using single-crystal X-ray diffraction data. The molecule crystallizes in the orthorhombic Pbca space group. in the unit cell four molecular conformers of the compound per asymmetric unit are observed, which are forming beta helix arrangement along [010] direction. Hirshfeld surface calculation was performed to determine the intermolecular interactions that contribute to the crystal packing. it was possible to observe that the main contribution to the general surface is given by the contacts H ••• H (34.8%), followed by interactions O ••• H/H ••• O (27%) and C ••• H/H ••• C (18.6%). The energy interaction networks were calculated at a DFT/B3LYP/6-31G(d,p) level, allowing to quantify the high participation of dispersion interactions (-57.5 kJ/mol) in the formation of crystal packing.
Resumo A estrutura cristalina do composto ácido 2-E-((4-hidroxifenil) diazenil) benzóico foi resolvida pelo método da fase intrínseca usando dados de difração de raios X de cristal único, constatando que a molécula cristaliza no sistema cristalino ortorrômbico com grupo espacial Pbca. Dentro de sua cela unitária, existem quatro moléculas por unidade assimétrica, que são isômeros moleculares. Esses isômeros formam hélices beta na direção [010]. A partir dos dados estruturais, foi realizado o cálculo das superfícies de Hirshfeld determinando a partir delas seus respetivos diagramas bidimensionais das impressões digitais, o que permitiu estudar as interações intermoleculares que mais contribuem para o empacotamento cristalino. Assim, foi determinado que a principal contribuição para a superfície geral é dada pelos contatos H ••• H (34,8%), seguidos pelas interações O ••• H / H••• O (27%) e C ••• H / H ••• C (18,6%). Também foram calculadas as redes de energia de interação com um nível de teoria DFT/B3LYP/6-31G(d,p), permitindo quantificar a alta participação de interações de dispersão (-57,5 kJ / mol) na formação do empacotamento cristalino para este composto.
Résumé
Introducción: la extracción del cristalino transparente en pacientes con cierre angular primario se plantea si existe presión intraocular mayor o igual que 30 mm Hg o daño por glaucoma. En ojos con elevación moderada de la presión intraocular se desconocen los resultados. Objetivo: evaluar la influencia de la presión intraocular preoperatoria en el control del cierre angular primario tratado con extracción del cristalino transparente. Material y Métodos: se realizó un estudio pre-experimental, entre enero de 2013 y enero de 2020, incluyó 78 ojos de 78 pacientes con cierre angular primario tratados con extracción del cristalino transparente; divididos en dos grupos según presión intraocular preoperatoria. Para el análisis estadístico se empleó chi cuadrado de independencia, probabilidad exacta de Fisher, prueba t para muestras independientes y análisis de varianza de medidas repetidas; con significación estadística del 95 por ciento. Resultados: hubo diferencias significativas entre ambos grupos para longitud axial (p=0,003), grosor del cristalino (p<0,001) y espesor corneal central (p=0,016). La presión intraocular y número de colirios, variaron de forma muy significativa (p<0,001) entre el pre y posoperatorio, y entre ambos grupos en los diferentes momentos analizados. En el grupo A el 94,4 por ciento de los ojos mostró control absoluto posoperatorio invariable en el tiempo, en el grupo B la mayoría de los ojos tuvo control relativo con diferencias muy significativas (p<0,001) entre ambos. Conclusiones: la presión intraocular preoperatoria influye en el control del cierre angular primario tratado con extracción del cristalino transparente; valores previos menores que 30 mm Hg, propician mejor control posoperatorio(AU)
Introduction: Clear lens extraction is considered in patients older than 50 years with primary angle closure and intraocular pressure greater than or equal to 30 mm Hg or damage due to glaucoma. The results are unknown in eyes with a moderate elevation of intraocular pressure. Objective: To evaluate the influence of preoperative intraocular pressure in the control of the primary angle closure treated with clear lens extraction. Material and Methods: A pre-experimental study was conducted between January 2013 and January 2020. It included a total of 78 eyes of 78 patients with primary angle closure treated with clear lens extraction. They were divided into two groups according to preoperative intraocular pressure. For statistical analysis, Chi-square test, Fisher's exact probability test, and t test were used for independent samples and analysis of variance with repeated measurements; with 95 percent statistical significance. Results: There were significant differences in axial length (p=0,003), lens thickness (p<0,001) and central corneal thickness (p=0,016) between both groups. Intraocular pressure and the number of eye drops varied very significantly (p<0,001) between the pre-and postoperative periods and between both groups at the different moments analyzed. In group A, 94,4 percent of the eyes showed absolute postoperative control, which remained unchanged over time. In group B, most eyes had relative control. There were very significant differences (p<0,001) between both groups. Conclusions: Preoperative intraocular pressure influences the control of primary angle closure treated with clear lens extraction; previous values less than 30 mm Hg favor better postoperative control(AU)
Sujets)
Humains , Mâle , Femelle , Glaucome/prévention et contrôle , Pression intraoculaire , Pression intraoculaire/physiologie , Cristallin , Période postopératoireRésumé
ABSTRACT This study aimed to analyze the anterior lens capsule specimens from both eyes of a patient with systemic sclerosis and compare them to the eyes of a control patient. No significant differences between systemic sclerosis and control eyes were observed in the results from the hematoxylin-eosin and picrosirius staining. In the samples obtained from both systemic sclerosis and control eyes, there were expressions of caspase, a molecule expressed in cell death by apoptosis. Heparanase was overexpressed in the systemic sclerosis sample compared to the control sample. Therefore, the anterior lens capsule of the patient with systemic sclerosis is probably affected by the disease since it showed marked expression of heparanase 1.(AU)
RESUMO Analisamos as amostras das cápsulas anteriores do cristalino de uma paciente com esclerose sistêmica e comparamos com as de um paciente controle. Não foram observadas diferenças significativas entre esclerose sistêmica e controle nos resultados da coloração com hematoxilina-eosina e picrosirius. Nas amostras obtidas da esclerose sistêmica e do controle, obtivemos expressão de caspase, uma molécula expressa na morte celular por apoptose. A heparinase foi expressa de forma mais marcante na amostra de esclerose sistêmica quando comparada ao controle. Portanto, a cápsula anterior do cristalino da paciente com esclerose sistêmica provavelmente foi afetada pela doença, uma vez que mostrou expressão aumentada de heparinase 1.(AU)
Sujets)
Humains , Sclérodermie systémique/physiopathologie , Heparin lyase/administration et posologie , Hématoxyline , Capsule du cristallin/anatomie et histologieRésumé
Abstract Species lists available from floristic and phytosociological studies contain important information about species distributions that are useful for making biogeographical inferences and even to evaluate conservation status of species and ecosystems. In the case of the Caatinga, this information may contribute to challenging the pre-established idea that it is a homogeneous vegetation unit. The strong relation between the substrate and the plant assemblages of the Caatinga may characterise different types of vegetation. In this way, the objective of the present study is to evaluate whether differences in the distribution of Cactaceae relate to distinctive types of substrate (sedimentary and crystalline) as much in terms of floristic richness as species density. Concomitantly, we evaluated the conservation status of the Caatinga areas studied. To obtain the data, we undertook a bibliographic revision of floristic and phytosociological studies in the Caatinga and constructed a similarity matrix using the selected floristic studies in order to evaluate the relation among different areas of Caatinga. We found that 48 areas included Cactaceae species; 33 species distributed in 14 genera were recorded. Among these taxa, Cereus jamacaru was the species that presented the largest number of occurrences, appearing in 17 areas, followed by Pilosocereus gounellei (=Xiquexique gounellei), found in 11 studies, and Tacinga inamoena in 10. The grouping analysis resulted in the formation of 10 groups, with a remarkable relationship between species and soil type. There were differences in both the diversity and density of species related with the degree of conservation of the Caatinga, noticeable from the direct relationship between conservation and richness and, indirectly, between density and number of species.
Resumen Las listas de especies presentadas en trabajos florísticos o fitosociológicos proporcionan importante información sobre distribución, útil para realizar inferencias biogeográficas y evaluar el estado de conservación de especies o incluso de ecosistemas. En el caso de los bosques secos del nordeste de Brasil, conocidos como Caatinga, el análisis de esas listas puede contribuir para confrontar ideas previamente establecidas sobre la homogeneidad de esa unidad de vegetación. La fuerte relación entre el sustrato y los ensambles de plantas de la Caatinga pueden caracterizar distintos tipos de vegetación. Es así como, el objetivo de este trabajo es evaluar sí la distribución de Cactaceae está relacionada con los tipos de sustrato (sedimentar y cristalino), sea con la riqueza florística o la densidad de las especies. Al mismo tiempo, evaluamos el estado de conservación de las áreas estudiadas de la Caatinga. Los datos fueron obtenidos a partir de revisiones bibliográficas, de estudios de florística y fitosociología en la Caatinga. Para evaluar las distintas áreas, con los estudios florísticos seleccionados se preparó una matriz de similaridad. Se encontró que, 48 áreas tenían especies de Cactaceae; 33 especies distribuidas en 14 géneros fueron listadas. Cereus jamacaru fue la especie con el mayor número de puntos en 17 áreas, seguido por Pilosocereus gounellei (=Xiquexique gounellei), encontrado en 11 estudios y Tacinga inamoena, en 10. El análisis resultó en la formación de 10 grupos con fuertes relaciones entre especies y tipos de sustratos. También, encontramos diferencias en diversidad de especies en relación con el estado de conservación de la Caatinga, notable por las relaciones directas entre conservación y riqueza de especies, e indirectas entre densidad y número de especies.
Résumé
ABSTRACT The term dysfunctional lens syndrome has gained acceptance in the field and encompasses natural changes due to aging of crystalline lens. The evolution of diagnostic devices has been a key factor in better staging, understanding and characterizing of these degenerative changes. Even with these technological advances and the use of subjective classifications, such as the classic Lens Opacities Classification System, an objective staging of early dysfunctional lens syndrome has yet to be established. Ocular wavefront aberrometry and objective scatter index, associated with Scheimpflug backscatter densitometry, have proven instrumental in detecting early dysfunctional lens syndrome. Staging of early dysfunctional lens syndrome has been proposed in the literature, but no classification has been recognized worldwide. The purpose of this literature review is to assess the current state of dysfunctional lens syndrome from a technological perspective and propose a new staging system to assist surgeons in making surgical decisions.
RESUMO O termo "síndrome disfuncional do cristalino" tem sido mais aceito na área e engloba mudanças naturais devido ao envelhecimento do cristalino. A evolução dos dispositivos diagnósticos tem sido fator fundamental para melhor estadiamento, compreensão e caracterização dessas alterações. Mesmo com esses avanços tecnológicos e o uso de classificações subjetivas, como o Lens Opacities Classification System , um estadiamento objetivo da síndrome disfuncional do cristalino precoce ainda não foi estabelecido. A aberrometria ocular total e o índice de superfície ocular, associado à densitometria de Scheimpflug, mostraram-se instrumentais na detecção da síndrome disfuncional do cristalino precoce. Embora estadiamentos precoces de síndrome disfuncional do cristalino tenham sido propostos na literatura, nenhum foi reconhecido mundialmente até o momento. O objetivo desta revisão de literatura é avaliar o estado atual da síndrome disfuncional do cristalino a partir de uma perspectiva tecnológica, e propor um novo sistema de estadiamento para auxiliar os cirurgiões na tomada de decisões cirúrgicas.
Sujets)
Humains , Accommodation oculaire/physiologie , Cristallin , Maladies du cristallin/imagerie diagnostique , Presbytie , Cataracte , Imagerie diagnostique/méthodes , Acuité visuelle , Techniques de diagnostic ophtalmologique , Aberration du front d'onde cornéenRésumé
El trauma ocular es una causa frecuente de consulta en los servicios de oftalmología, es más frecuente en el género masculino. Dependiendo de la gravedad del daño ocasionado, el tratamiento representa un reto para el oftalmólogo, porque, se enfrenta ante un daño patológico integral y complejo. El presente caso corresponde a un paciente masculino con baja de agudeza visual importante en ojo derecho, con antecedente de trauma ocular contuso, ocasionado con una piedra, en su ambiente laboral, que acude dos meses posterior al trauma ocular. Al examen presenta secuelas del trauma ocular contuso, fibrosis capsular anterior, catarata traumática, subluxación de cristalino, etc. El pronóstico visual tras un procedimiento quirúrgico es bueno, sin embargo, el paciente rechaza la cirugía. Por lo tanto, es muy importante el uso de lentes de trabajo que puede prevenir accidentes laborales.
The ocular trauma is a frequent cause of consultation in ophthalmology services, it is more frequent in males. Depending on the severity of the damage caused, the treatment represents a challenge for the ophthalmologist, because, he faces an integral and complex pathological damage. The present case corresponds to a male patient with low visual acuity in the right eye, with a history of blunt eye trauma, caused by a stone, in his work environment, who came two months after the eye trauma. On examination, he presented sequels of blunt ocular trauma, anterior capsular fibrosis, traumatic cataract, lens subluxation, etc. The visual prognosis after a surgical procedure is good, however, the patient rejects the surgery. Therefore, it is very important to wear work glasses that can prevent workplace accidents.
Sujets)
Conseil de Santé SudAméricainRésumé
ABSTRACT Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.
RESUMO Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.
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Humains , Repositionnement des médicaments , Lentilles intraoculaires , Complications postopératoires , Acuité visuelle , Subluxation du cristallin , Études rétrospectivesRésumé
ABSTRACT Purpose: To describe costs and outcomes of phacoemulsification for cataracts performed by ophthalmology residents. Methods: We obtained medical records from patients operated on in 2011 by third year residents (R3) using phacoemulsification (n=576). Our expenses estimation included professionals' and hospital costs (fees, materials, medications, and equipment). The study outcomes included spectacle-corrected visual acuities before and six months after the operation, rate of intraoperative complications, and total number of postoperative visits. We compared outcome variables with those from extracapsular cataract extraction procedures (n=274) performed by R3 residents in 1997. Results: The mean total cost for phacoemulsification was US$ 416, while an overall estimation indicated the extracapsular cataract extraction cost at US$ 284 (as of December 30, 2011). The mean preoperative spectacle-corrected visual acuity was worse for eyes scheduled for extracapsular cataract extraction (1.73 ± 0.62), than for eyes scheduled for phacoemulsification (0.74 ± 0.54 logMAR) (p<0.01); the mean postoperative visual acuity was better for phacoemulsification (0.21 ± 0.36 logMAR), than for extracapsular cataract extraction (0.63 ± 0.63 logMAR) (p<0.01). Most patients undergoing phacoemulsification (85%) achieved postoperative spectacle-corrected visual acuities ≥0.30 logMAR, while only 45% of those undergoing extracapsular cataract extractions achieved the same postoperative visual acuity (p<0.01). The rate of intraoperative complications was significantly higher after extracapsular cataract extractions (21%) than it was after phacoemulsifications (7.6%) (p<0.01), and the mean number of postoperative visits was also higher after extracapsular cataract extractions (5.6 ± 2.3) than after phacoemulsifications (4.5 ± 2.4) (p<0.01). Conclusion: These data indicate that cataract surgery performed by in-training ophthalmologists using phacoemulsification is expensive, but compared to extracapsular cataract extraction results, teaching phacoemulsification leads to an approximate three-fold lower complication rate, smaller number of postoperative visits and, most importantly, better visual acuities.
RESUMO Objetivo: Descrever os custos e resultados da facoemulsificação na cirurgia de catarata realizada por médicos residentes de oftalmologia. Métodos: Foram obtidos prontuários médicos de pacientes operados em 2011 por residentes do terceiro ano (R3) usando facoemulsificação (n=576). Nossa estimativa de despesas incluiu os custos profissionais e hospitalares (taxas, materiais, medicamentos e equipamentos). Os desfechos do estudo incluíram acuidade visual corrigida por óculos pré-operatória e 6 meses após a cirurgia, taxa de complicações intraoperatórias e número total de visitas pós-operatórias. Nós comparamos as variáveis de resultados com procedimentos extracapsulares de extração de catarata (n=274) realizados por residentes R3 em 1997. Resultados: O custo médio da facoemulsificação foi US$ 416, enquanto uma estimativa geral indicou o custo da extração de catarata extracapsular seria de US$ 284 (em 3 de dezembro de 2011). A acuidade visual corrigida por óculos média pré-operatória foi pior na extração de catarata extracapsular (1,73 ± 0,62 logMAR) do que na facoemulsificação (0,74 ± 0,54, p<0,01); a acuidade visual corrigida por óculos média pós-operatória foi melhor na facoemulsificação (0,21 ± 0,36 logMAR) do que na extração de catarata extracapsular (0,63 à facoemulsificação (85%) atingiram acuidade visual corrigida 45% daqueles submetidos à extrações extracapsulares de catarata obtiveram a mesma acuidade visual pós-operatória (p<0,01). A taxa de complicações intraoperatórias foi significativamente maior após extrações de catarata extracapsular (21%) do que após as facoemulsificações (7,6%) (p<0,01) e o número médio de consultas pós-operatórias também foi maior após extração de catarata extracapsular (5,6 ± 2,3) do que após facoemulsificações (4,5 ± 2,4) (p<0,01). Conclusão: Esses dados indicam que a cirurgia de catarata realizada por oftalmologistas em treinamento utilizando facoemulsificação é dispendiosa, mas comparada aos resultados da extração de catarata extracapsular, o ensino da facoemulsificação leva a uma taxa de complicações aproximadamente 3 vezes menor, menor número de consultas pós-operatórias e, mais importante, melhor acuidade visual.
Sujets)
Humains , Cataracte , Phacoémulsification , Complications postopératoires , Acuité visuelle , Études rétrospectives , Résultat thérapeutique , Complications peropératoiresRésumé
ABSTRACT This report describes the therapeutic effects and outcomes of an accidental injection of an intralenticular sustained-release dexamethasone implant (Ozurdex®) in three patients with diabetic macular edema. All three patients underwent accidental injections of sustained-release intravitreal dexamethasone implants into the crystalline lens by the same surgeon. After the accidental injection of Ozurdex® into the crystalline lens, a remarkable reduction in the macular edema and an improvement in visual acuity were observed, suggesting that a positive outcome can be achieved without immediate surgery.
RESUMO Este estudo descreve os efeitos terapêuticos e os resultados de uma injeção acidental de implante intralenticular de dexametasona de liberação sustentada (Ozurdex®) em três pacientes com edema macular diabético. Todos os três pacientes foram submetidos a injeções acidentais de implantes intravítreos de dexametasona de liberação sustentada na lente do cristalino pelo mesmo cirurgião. Após a injeção acidental de Ozurdex® na lente do cristalino, observou-se uma redução notável no edema macular e uma melhora na acuidade visual, sugerindo que um resultado positivo pode ser alcançado sem cirurgia imediata.
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Humains , Dexaméthasone , Oedème maculaire , Rétinopathie diabétique , Cristallin , Implant pharmaceutique , Injections intravitréennes , GlucocorticoïdesRésumé
Resumen Objetivo: Determinar la efectividad de la técnica manual de cirugía de catarata con incisión pequeña (MSICS) considerando agudeza visual, astigmatismo postoperatorio, complicaciones perioperatorias y mejora de la calidad de vida de los pacientes en función de la visión. Material y métodos: Estudio observacional, descriptivo, de corte transversal de pacientes operados de catarata con MSICS, entre el 2 de noviembre del 2009 y 30 de abril del 2010 en un centro oftalmológico privado de Lima. Se registraron las características demográficas y socioeconómicas, agudeza visual (AV), complicaciones perioperatorias, astigmatismo pre y postoperatorio y calidad de vida en función de la visión (CVFV). Resultados: Se realizaron 806 cirugías en 591 pacientes. La media de edad fue 75 años, 304 (51,49%) casos fueron del sexo femenino y 501 (84,74%) procedentes de Lima Metropolitana. Al alta, la AV sin corrección fue de 20/40 o mejor en 481 casos (59,64%), con astigmatismo quirúrgicamente inducido menor de 2,00 D en 732 (90,80%). En 64 (7,94%) casos ocurrieron complicaciones intraoperatorias y en 52 (6,45%), postoperatorias. La percepción de la CVFV del paciente en función de la visión a los 30 días fue: "Buena" en 311 (41,25%), "Muy Buena" en 405 (53,71%) con diferencia significativa (p<0.05) en relación a la evaluación preoperatoria. Conclusiones : El MSICS es una técnica quirúrgica altamente efectiva considerando una buena agudeza visual y bajo astigmatismo inducido postoperatorios, bajo porcentaje de complicaciones y significativa mejora de la CVFV del paciente.
Objective: To determine the effectiveness of the manual technique of cataract surgery with small incision (MSICS) considering visual acuity, postoperative astigmatism, perioperative complications and improvement of the quality of life of patients based on vision. Methods: Observational, descriptive, cross-sectional study in patients operated on cataract with MSICS, between November 2, 2009 and April 30, 2010 in a private ophthalmological center in Lima. Demographic and socioeconomic characteristics, visual acuity (VA), perioperative complications, pre and postoperative astigmatism and quality of life based on vision (CVFV) are included. Results: 806 surgeries were performed in 591 patients. The mean age was 75 years, 304 cases (51.49%) were female and 501 (84.74%) from Metropolitan Lima. The VA without correction at discharge was 20/40 or better in 481 (59.64%) cases, with surgically induced astigmatism less than 2.00 D in 732 (90.80%). Intraoperative complications occurred in 64 cases (7.94%) and postoperative complications in 52 (6.45%). The patient's CVFV perception based on vision at 30 days was "Good" in 311 (41.25%), "Very Good" in 405 (53.71%) with significant difference (p <0.05) in relation to the preoperative evaluation. Conclusions: The MSICS is a highly effective surgical technique considering good visual acuity and low postoperative induced astigmatism, low percentage of complications and significant improvement of the patient's CVFV.
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Introducción. El glaucoma de ángulo cerrado es una causa importante de ceguera que incrementa con la edad y que afecta principalmente a las mujeres. Este problema es la primera causa de discapacidad visual no reversible en El Salvador. Objetivo. Caracterizar clínica y morfológicamente el ángulo iridocorneal y cristalino en glaucoma por ángulo cerrado en pacientes atendidos entre mayo y julio de 2018 en el Hospital Nacional Rosales. Metodología. Estudio transversal descriptivo que incluyó a pacientes diagnosticados por primera vez con glaucoma en el Hospital Nacional Rosales, entre mayo y julio de 2018. En total, se incluyeron a 22 pacientes. Resultados. El 77.0 % son mujeres entre 51 y 60 años. La agudeza visual se encontró reducida en más del 90.0 %. La mayoría de personas presenta una presión intraocular de 30 mmHg. La profundidad de la cámara anterior en la mayoría de los pacientes se encuentra disminuida. La mayoría tienen ángulo cerrado con aumento del diámetro y del espesor del cristalino. Conclusión. El glaucoma de ángulo cerrado fue más frecuente en mujeres, de mayor rango de edad y con cambios característicos en la morfología de la cámara anterior del ojo e incremento de la presión intraocular
Introduction. Closed-angle glaucoma is an important cause of blindness that increases with age and mainly affects women. This problem is the first cause of non-reversible visual impairment in El Salvador. Objective. Clinically and morphologically characterize the iridocorneal and crystalline angle in patients with closed angle glaucoma, treated between May and July 2018 at the Hospital National Rosales. Methodology. Descriptive cross-sectional study that included patients first diagnosed with glaucoma at Rosales National Hospital, between May and July 2018. In total, 22 patients were included. Results 77 % were women between 51 and 60 years. Visual acuity was reduced by more than 90%. Most people had an intraocular pressure of 30 mmHg. The depth of the anterior chamber in most patients is diminished. Most have a closed angle with an increase in the diameter and thickness of the lens. Conclusion. Closed angle glaucoma was more frequent in women, of greater age range and with characteristic changes in the morphology of the anterior chamber of the eye and increased intraocular pressure.
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Humains , Ophtalmologie , Lésions traumatiques de l'oeil , SalvadorRésumé
Abstract: Vegetation associated with rocky outcrops is responsible for increasing floristic and landscape diversity, since its flora can be different from the adjacent landscape. Our objective was to characterize the woody vegetation associated with the rocky outcrop of the RPPN Mirante da Serra, Cristalino region, Mato Grosso State, Brazil. In a Deciduous Seasonal Forest associated with granite outcrops, we demarcated a plot of 1ha. We performed collections on this plot, installed for conducting monitoring studies, and also random collections on trails near the plot to better represent the outcrop flora. We totaled 126 species, 95 genera and 39 families. Overall, 18 species were increased to the Flora of Cristalino - with seven new records to the flora of Mato Grosso and four new records to the Amazon Domain. We found two threatened and 17 Brazilian endemic species. The rocky outcrop present in the RPPN Mirante da Serra is an important conservation area for a continuous execution of floristic studies in a manner to enable a monitoring program of the area, considering the new occurrence records and also because it contains threatened species.
Resumo: A vegetação que se associa a afloramentos rochosos é responsável por incrementar a diversidade florística e de paisagens, uma vez que a flora pode ser distinta da paisagem circundante. Nosso objetivo foi caracterizar a vegetação lenhosa sobre o afloramento rochoso da RPPN Mirante da Serra, região do Cristalino, estado de Mato Grosso, Brasil. Em uma Floresta Estacional Decidual associada a afloramento granítico, demarcamos uma parcela de 1 ha. Realizamos coletas nesse plot, instalado para a realização de estudos de monitoramento e, ainda, coletas aleatórias em trilhas próximas da parcela para melhor representar a flora do afloramento. A amostragem resultou em um total de 126 espécies, 95 gêneros e 39 famílias. Ao todo, 18 espécies foram incrementadas à Flora do Cristalino, das quais sete são novos registros à flora do estado de Mato Grosso e quatro ao Domínio da Amazônia. Encontramos duas espécies ameaçadas e 17 endêmicas do Brasil. O afloramento rochoso presente na RPPN Mirante da Serra é uma importante área de conservação para uma contínua realização de estudos florísticos de modo a possibilitar um programa de monitoramento da área, considerando os novos registros de ocorrência e, também, por conter espécies ameaçadas.
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Abstract Objective: To determine the association between occupational ionizing radiation exposure in the cardiovascular catheterization laboratories staff and development of lens changes. Methods: A cross-sectional study was made. Participants were recruited at the XIII Colombian Conference of Interventional Cardiology and SOLACI conferences in Bogotá - Colombia 2017. Informed consent was obtained from all study participants. Demographics and clinical data were collected. Associated lens changes were determined according to the ionizing radiation exposure status. Results: A total of 89 subjects (178 eyes) participated in the study. In general, the mean age was 40 years old, ranging from 19 to 78 years old. Distribution according gender was 55.3% male and 44.7% female. 31 subjects (62 eyes) were deemed to have not occupational exposure to radiation and 58 subjects (116 eyes) with a history of occupational radiation exposure. Exposed eyes had twice risk for present subcapsular posterior lens opacity compared to non-exposed eyes. The subjects with older age and physician role were associated to the presence of lens opacity, with a p value 0.001 in both cases. Likewise, exposed subjects with any lens opacity had a high mean occupational lifetime, with a p 0.001. Conclusions: This study confirms a statistically significant increase in radiation-associated subcapsular lens changes in the eyes of interventional cardiology staff compared to unexposed controls.
Resumen Objetivo: Determinar la asociación entre la exposición a radiación ionizante en el personal de las salas de cateterismo cardiovascular y el desarrollo de cambios en el cristalino. Métodos: Se hizo un estudio transversal. Los participantes fueron reclutados en el XIII Congreso Colombiano de Cardiología Intervencionista y las Conferencias SOLACI en Bogotá - Colombia 2017. Se obtuvo el consentimiento informado de todos los participantes. Se recolectaron datos demográficos y clínicos. Se determinó la asociación entre los cambios en el cristalino y la exposición a la radiación ionizante. Resultados: Un total de 89 sujetos (178 ojos) participaron en el estudio. En general, la edad promedio fue de 40 años, con edades comprendidas entre los 19 años y 78 años. La distribución según el género fue del 55,3% en hombres y el 44,7% en mujeres. Se consideró que 31 sujetos (62 ojos) no tenían exposición ocupacional a la radiación y 58 sujetos (116 ojos) presentaban exposición ocupacional a esta. Los ojos expuestos tenían dos veces el riesgo de presentar opacidad subcapsular posterior del cristalino en comparación con los ojos no expuestos. Los sujetos de mayor edad y con rol de médico se asociaron a la presencia de opacidad del cristalino, con un valor p de 0.001 en ambos casos. Del mismo modo, los sujetos expuestos con cualquier opacidad del cristalino tenían una vida laboral más larga, con una p 0.001. Conclusiones: Este estudio confirma un aumento estadísticamente significativo en la presencia de cambios en el cristalino en el personal de las salas de cateterismo cardiovascular en comparación con los controles no expuestos.
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Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Rayonnement ionisant , Cataracte , Exposition professionnelle , Études transversales , OeilRésumé
ABSTRACT Fabry disease is a rare X-linked disorder caused by an alpha-galactosidase enzyme deficiency, which leads to a progressive lysosomal glycosphingolipids accumulation, mainly globotriaosylceramide, in multiple organism tissues including the eye. This case series describes the first ophthalmological Colombian report of Fabry disease highlighting the importance of ocular signs as markers of the disease, useful in diagnosis and treatment to avoid long-term complications that lead to a morbi-mortality increment. We describe five cases of Fabry disease from Bogotá, Colombia, including a complete clinical history, ophthalmologic, optometric examination, and photographs. We found that all patients had refractive defects and that in all cases corneal verticillata pattern was found. Four patients presented with posterior capsule lens brown-beige deposits and four patients had conjunctival and retinal tortuous vessels. A complete ophthalmologic examination is important for prompt diagnosis, which is key to starting a multidisciplinary treatment and reducing morbi-mortality.
RESUMEN La enfermedad de Fabry es un raro trastorno ligado al cromosoma X causado por deficiencia de la enzima alfa-galactosidasa y la consiguiente y progresiva acumulación lisosómica de glucoesfingolípidos, especialmente la globotriaosilceramida, en múltiples tejidos del organismo, incluido el ojo. En este reporte se presenta la primera serie de casos de manifestaciones oculares de la enfermedad de Fabry en Colombia, resaltando la importancia de los signos oculares como ayuda para el diagnóstico temprano. Se presentan cinco casos de la enfermedad en Bogotá y se da cuenta de las historias clínicas y los exámenes oftalmológicos y de optometría, y se incluyen fotografías. En todos los pacientes se hallaron errores de refracción y se evidenció el patrón de córnea verticillata. Cuatro pacientes presentaban depósitos de color café y castaño claro en la cápsula posterior del cristalino, y cuatro tenían tortuosidad vascular conjuntival y retiniana. El examen oftalmológico completo es importante para hacer un diagnóstico oportuno con el fin de iniciar el tratamiento multidisciplinario y reducir la morbimortalidad.
Sujets)
Adolescent , Adulte , Femelle , Humains , Mâle , Jeune adulte , Maladie de Fabry/complications , Maladies de l'oeil/diagnostic , Troubles de la réfraction oculaire/diagnostic , Vaisseaux rétiniens/malformations , Cataracte/diagnostic , Amblyopie/diagnostic , Maladie de Fabry/génétique , Colombie , Conjonctive/malformations , Conjonctive/vascularisation , Hétérozygote , Appareil lacrymal/malformationsRésumé
RESUMEN 24. El síndrome de Alport es un trastorno genético raro causado por mutaciones en los genes del colágeno tipo IV, caracterizado por insuficiencia renal, hipoacusia neurosensorial y anomalías oculares. Se presenta el caso de un paciente de 24 años con un cuadro de un día de disminución súbita de la agudeza visual en el ojo izquierdo, posterior a ruptura espontánea de la cápsula anterior del cristalino, asociado a catarata, uveítis facolítica e hipertensión ocular. En la anamnesis se encontraron antecedentes personales de hipoacusia e insuficiencia renal y, dos familiares con el diagnóstico clínico de síndrome de Alport. El heredograma sugirió una herencia dominante ligada al cromosoma X. Se inició el tratamiento tópico con prednisolona, atropina y brimonidina/timolol. Posteriormente, se realizó facoemulsificación y aspiración de restos de cristalino, con mejoría del cuadro clínico.
SUMMARY 30. Alport syndrome is a rare genetic disorder due to mutations involving the coding genes for type IV collagen characterized by renal failure, sensorineural hearing loss and ocular abnormalities. This article presents a 24-year-old man with one day of sudden decrease in visual acuity in left eye due to spontaneous rupture of anterior lens capsule, related to cataract, phacolytic uveitis and ocular hypertension. In the anamnesis, personal history of hearing loss, renal failure and two-family members with a clinical diagnosis of Alport syndrome were found. The inheritance map was suggestive of a dominant inheritance X-linked pattern. Topical treatment was initiated with prednisone, atropine and brimonidine/timolol. Subsequently, phacoemulsification and aspiration of lens residues was performed, obtaining clinical relief.